We recently sat down with Dara Yomjinda, Clinic Manager of the CLARE|MATRIX Opioid Treatment Program in Los Angeles, to learn more about how the opioid crisis is affecting this region. Here’s what she shared:
Tell us about what treatment services our Los Angeles clinic provides.
We provide medications for opioid use disorder (methadone, buprenorphine and naltrexone), individual and group counseling, case management, a 12-Step group for people on medication assisted treatment (heroin anonymous), and HIV and Hepatitis testing. Through partnerships with other local community agencies, we also offer STD testing and education as well as needle exchange services on site. We have a clinic census of about 233 participants annually.
What are the reasons/trends as to why we are seeing a rising increase in the opioid crisis in Los Angeles County as well as California?
There has been significant increases in overdose deaths involving synthetic opioids in this region – particularly those involving illicitly-manufactured fentanyl (IMF). The IMF market continues to change, and IMF can be found in combination with heroin, counterfeit pills, and cocaine. (To view opioid epidemic figures from the CDC, click here.)
Has this clinic seen a sharp increase in opioid drug abuse in Los Angeles County over the past several years?
Not so much of an increase in the past several years. Although compared to seven years ago, we have seen about a 25% increase in the amount of people we serve. However, this may correlate with Medicaid expansion and more people being able to access treatment. What we have recently noticed is a shift in the demographics of the people seeking treatment. They are whiter, younger, and have less experience being in treatment and with medication assisted treatment.
Is the opioid crisis as severe in Los Angeles County as in the rest of the state and country?
Los Angeles County has a higher prevalence rate of misusing/abusing prescription opioids than the national average and the fourth highest number of drug overdoses in the nation (although a lower mortality rate than the overall U.S. rate). In general, L.A. County is probably in a better position than other parts of the country where treatment is not readily available or accessible/affordable. For instance, rural areas of California and the nation often have higher overdose rates due to the lack of medication assisted treatment availability/accessibility.
How has this clinic worked to effectively treat clients who have struggled with opioid drug abuse?
We are a licensed Opioid Treatment Program and provide medications for opioid use disorder to address withdrawal symptoms and help people stabilize and feel “normal”. We also provide medication (Narcan) to reverse opioid overdoses and training on how to administer the medication to participants and the community members. In addition to medication, we provide counseling (individual and group) using evidence-based practices (Matrix Model, Motivational Interviewing, Cognitive Behavioral Therapy, Seeking Safety) as well as case management services.
We use a harm reduction approach and focus on reducing high risk-behaviors to help our participants stay alive and improve their quality of life. We also work collaboratively within our agency and with external providers to provide a continuum of care to our participants to help ensure all their needs are met, whenever possible. We are fortunate to have been awarded treatment grants from the Substance Abuse and Mental Health Services Administration, which allow us to provide treatment at no cost for participants who are uninsured or underinsured.
How has the Matrix model made an impact in treating the local population in the opioid crisis?
Using the Matrix Model helps participants gain insight into their substance use and develop the behavioral skills needed to address it. For instance, participants and their family members receive psychoeducation on the disease and learn about the effects on the brain. Participants also learn early recovery and relapse prevention skills, such as identifying triggers and healthy coping skills, and are encouraged to develop positive social support systems through outside self-help support groups, for example. While the medication does a lot of the “heavy lifting,” developing these cognitive and behavioral skills and developing one’s social support networks help improve overall treatment outcomes.
Are there any cessation methods that your clinic recommends to the public to help prevent opioid drug abuse on a macro level?
Medication assisted treatment is the gold standard of treatment for opioid use disorders. It is the method with the most evidence supporting it. Quite simply, it saves lives. Unfortunately, there is still a lot of shame and stigma associated with addiction. It’s important for the public to see and treat opioid use disorder as the chronic medical condition it is. On a macro level, this means we need to work to change how we talk about addiction (away from shame-based language and addiction as a moral failing), increase the availability of evidence-based treatment, and increase access to treatment. We need to accept the fact that as a chronic disease it may require being on medication indefinitely, and that this is OK.